Walsall Cardiac Rehabilitation Walsall Cardiac Rehabilitation Trust (Heart Care)Trust (Heart Care)

12 Portland Street Streetly Community Centre

Walsall, WS2 8AB Foley Road, Streetly,

Sutton Coldfield

Telephone number:

01922 725050

Fax number 01922 659157

Email: office@heartcare.fsnet.co.uk

www.heartcare.org.uk

Manager: Suzanne Ursell

HistoryHistory Established since 1981 Trust Funds raised initially by local Rotary Clubs Continual fund-raising Ad hoc payments received for projects/bids put

forward to Hospital Trust and Metropolitan Borough Council

Service provided to MI patients only – referral from the local Hospital

Service development

Present Service ProvisionPresent Service Provision Referral process

– Manor Hospital – direct booking Cardiac Rehabilitation Nurse Heart Failure Nurse Specialist Community Cardiac Nurses Consultant Cardiologists

– GP Practices– Tertiary Centres – Heart and Lung Centre,

Wolverhampton– Self – Private

Who can attend?Who can attend? Heart attack Following by pass surgery Following cardiological intervention Stable Angina Heart Failure ‘Fit for Surgery’ Friends and relatives

What’s included?What’s included? Initial interview and assessment Exercise programme

– 8-13 weeks– Individually designed

Heart Failure

– Monitoring– Equipment used– Reassessment

Discharge letter Exit questionnaire

What’s included continuedWhat’s included continued Educational programme

– Medication– Exercise– Healthy Eating – Weight loss support group– Relaxation/Stress Management– General information– CPR– Specific talks covering:

Angina Fit for Surgery – contact number

What Else?What Else? GP Angina Programme

– Referral direct from GP – Similar referral protocol to After Care– Initial assessment– 8 weeks– Referral to Phase IV Community

After Care Programme Support Group Expert Patient Programme Referral to other agencies

– Quit smoking Team– Community Cardiac Nurses– Dietician– Stress Management Course– Employment Retention– Psychology

STATISTICS 2005/06STATISTICS 2005/06

10.5%

0143%

102.5%

9222%

6817%

11528%

10927%

409/384

Pts com-pleted

71%

20.5%

183.5%

163%

11021%

6913%

17132%

14426%

537Pts start

151.5%

30.5%

192%

284%

15219%

10513%

27634%

20926%

807Total Referral

OtherPaceHFValveCABGFit for

SurgeryPCI/Angina

MIGroups

FundingFunding

Part-funded by Walsall Primary Care Trust 3 year agreement Based on number of referrals received Subscriptions – after care service Fund-raising Trusts Donations

Cardiac Rehabilitation ServicesCardiac Rehabilitation Services

Two independent pathways and structures Hospital/Community Service

– Cardiac Rehab Liaison Nurse, Manor Hospital– Community Cardiac Nurses

MI patients Heart Failure Patients

Walsall Cardiac Rehabilitation Trust Relationship/Responsibility between two

pathways

CommunicationCommunication

Main flow between Hospital/Community Cardiac Rehabilitation Team and Walsall Cardiac Rehabilitation Trust

Phases– Phase 1 – Hospital Team– Phase 2 – Community Cardiac Nurses– Phase 3 – Walsall CRT– Phase 4 – Walsall CRT and Leisure Services

Where we are now

GP Referrals

NetworksNetworks Network Standard Group

– Clinical Lead– Service Improvement Facilitator– Chairman– Walsall, Dudley and Wolverhampton– Ad Hoc as necessary – Shropshire, Hereford &

Worcester

Aims and Benefits of working as Aims and Benefits of working as a Network Standard Groupa Network Standard Group

To work together to improve patient and carer services across the Black Country

Not reinventing the wheel Shared information Shared services/cost effective Linked patient pathways/paperwork Working with the other NSG groups across pathways Establishment of Action plansTo ensure that the service provision to patients is as

standard as possible

West Midlands StandardsWest Midlands Standards

Benefits of ‘Standards’ approach Maintain standards Identify:-

Strengths/weaknesses

Capacity issues

Workforce issues

Finance issues

Development opportunities

Relevant at local and network level

Proposed Flowchart for Patient and Carer Proposed Flowchart for Patient and Carer involvement in patient care and service involvement in patient care and service

provisionprovisionNetwork Board

Clinical Advisory Group

Network Standard Groups – AMI, Cardiac Rehabilitation, Heart Failure, Primary Care, Secondary Care, Surgery & Angina

Local questionnaires / Discovery Interviews / Feedback from local services

Network Patient and Carer Group

Local Groups

Patient Representative

WHAT NEXT?WHAT NEXT?

Thank youThank you

Any questions?